The effects of diabetes medications on post-operative long bone fracture healing.

PURPOSE: Diabetes has long been known to have an impact on bone repair. More recently, however, most diabetic patients receive medications to normalise this hyperglycaemic environment. To date, no studies have investigated the effects of diabetic medications on fracture healing in humans. METHOD: Patients were identified from two tertiary trauma centres. Inclusion criteria were adult patients having sustained a closed diaphyseal femoral or tibial fracture, treated surgically. Exclusion criteria were open, pathological or peri-prosthetic fractures, and patients having sustained polytrauma. Matched non-diabetic controls were identified, matched for age, sex, fracture classification and osteosynthesis. Output measures were: time to callus first appearance, bridging of involved cortices and time to union, along with the eventual outcome: union/non-union. RESULTS: A total of 36 (25 males) eligible patients were identified with a control group of 166 patients (138 males). ANOVA demonstrated class of medication to have a significant effect at two of the three time points and on the eventual outcome. Multiple regression analysis also demonstrated significant impact (p = 0.02). CONCLUSION: All classes of medication demonstrated anti-osteogenic effects compared to the control cohort. Biguanides demonstrated this in contrast to the in vitro evidence to date. Sulphonylureas demonstrated this to a greater extent; however, no in vitro evidence is available for comparison within this class. Clinicians should be aware of these delays in bone healing when treating diabetic patients and aim for optimal blood glucose control until such time as further research can be undertaken.

The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer-Irrigator-Aspirator system and antibiotic cement rods.

Intramedullary infection in long bones represents a complex clinical challenge, with an increasing incidence due to the increasing use of intramedullary fixation. We report a prospective case series using an intramedullary reaming device, the Reamer-Irrigator-Aspirator (RIA) system, in association with antibiotic cement rods for the treatment of lower limb long bone infections. A total of 24 such patients, 16 men and eight women, with a mean age of 44.5 years (17 to 75), 14 with femoral and 10 with tibial infection, were treated in a staged manner over a period of 2.5 years in a single referral centre. Of these, 21 patients had had previous surgery, usually for fixation of a fracture (seven had sustained an open fracture originally and one had undergone fasciotomies). According to the Cierny-Mader classification system, 18 patients were classified as type 1A, four as 3A (discharging sinus tract), one as type 4A and one as type 1B. Staphylococcus species were isolated in 20 patients (83.3%). Local antibiotic delivery was used in the form of impregnated cement rods in 23 patients. These were removed at a mean of 2.6 months (1 to 5). Pathogen-specific antibiotics were administered systemically for a mean of six weeks (3 to 18). At a mean follow-up of 21 months (8 to 36), 23 patients (96%) had no evidence of recurrent infection. One underwent a planned trans-tibial amputation two weeks post-operatively due to peripheral vascular disease and chronic recalcitrant osteomyelitis of the tibia and foot. The combination of RIA reaming, the administration of systemic pathogen-specific antibiotics and local delivery using impregnated cement rods proved to be a safe and efficient form of treatment in these patients.

Safety and immunogenicity of an inactivated hepatitis A vaccine: effect of dose and vaccination schedule.

The safety and immunogenicity of three doses (360 ELISA units [EU], 720 EU, and 1440 EU) and four immunization schedules (0, 1, and 2; 0, 1, and 6; 0, 1, and 12; 0, 2, and 4 months) of an inactivated hepatitis A vaccine were investigated in 80 healthy adult volunteers. Adverse effects were mild and comparable to those in a control group given hepatitis B vaccine. Antibody levels presumed to be protective (> or = 20 mIU/mL) were achieved after one injection in 90% of vaccinees given 360 and 720 EU and in 100% given 1440 EU. After two injections, 100% of vaccinees seroconverted regardless of the dose of vaccine given. All vaccine schedules were highly immunogenic. The accelerated and high-dose schedule could be useful for people who need to be rapidly immunized. The 12-month schedule induced very high levels of anti-hepatitis A virus but had problems with compliance. The 0-, 2-, and 4-month schedule produced higher antibody levels than the conventional 0-, 1-, and 6-month schedule (P = .016). This suggests that the hepatitis A vaccine could be incorporated into existing pediatric vaccine schedules.

Ketoconazole treatment of a family with zoonotic sporotrichosis.

All 3 members of a family developed lymphocutaneous and cutaneous sporotrichosis after exposure to an infected cat. The lesions resembled acute bacterial lymphadenitis and lymphangitis and responded within 2 weeks to ketoconazole treatment with complete healing and no recurrence over the next 6 months. Immunologically normal children and adults with lymphocutaneous or cutaneous sporotrichosis may respond well to ketoconazole therapy.

Diagnosis of Helicobacter pylori infection in adult and pediatric patients by using Pyloriset, a rapid latex agglutination test.

Pyloriset (Orion Diagnostica, Espoo, Finland) is a rapid antibody test using latex particles coated with acid-extracted antigen of Helicobacter pylori. We evaluated its ability to predict infection in 100 adult patients and 50 pediatric patients referred for gastric endoscopy. Sixty of 65 H. pylori-infected adults were correctly identified by the test. There were 12 false-positive and 5 false-negative reactions seen. Pyloriset had a sensitivity of 92% and a specificity of 66%. The positive predictive value was 83% and the negative predictive value 82%. In contrast, sensitivity dropped to 36% in the pediatric patients and the positive predictive value was only 40%. Pyloriset could become an important alternative to other more time-consuming diagnostic tests for H. pylori-infected adult patients but is inadequate for diagnosis of pediatric H. pylori infection.

Salmonellosis initially seen as a thyroid abscess.

A case of Salmonella typhimurium thyroid abscess in a 79-year-old man is reported. The patient was seen with fever and neck tenderness 2 weeks after a brief episode of diarrhea. Surgical excision combined with 2 weeks of ceftriaxone, 1 g every 12 hours, resulted in complete recovery. This is only the fourth known case of Salmonella thyroid abscess, 3 of which have been caused by S. typhimurium. This organism is rarely found in other focal Salmonella infections and may therefore have a specific affinity for thyroid tissue.

In vitro susceptibility of Helicobacter pylori to the new oral cephalosporins cefpodoxime, ceftibuten and cefixime.

The in vitro activity against 30 Helicobacter pylori strains of three new third generation cephalosporins, cefpodoxime, ceftibuten and cefixime, which can be administered orally, was determined using an agar dilution technique under microaerophilic conditions. The MIC50 and MIC90 of cefpodoxime was 0.5 and 4.0 micrograms/ml respectively, of ceftibuten 2.0 and 8.0 micrograms/ml, and of cefixime 0.06 and 0.5 microgram/ml. All antibiotics showed good activity against Helicobacter pylori, cefixime having the highest activity of the three agents.